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Sunday, 21 September 2014

In the early 1990s, in Ancoats
Hospital, Manchester I was a Senior House Officer in
Orthopaedics. I was warned when I joined about one of the consultants, Mr X,
who had a habit of hitting junior doctors assisting him at surgery with instruments
when the going got a little difficult. That was the most useful informal
induction that I could have ever had. It was bound to happen. I could attempt
to prepare for it.

My options, when it happened, were a) to
lodge a formal complaint with the hospital - as though that often did any good
to anyone b) to lodge an assault complaint with the police - which may or may
not have got any result but the career would have ground to a halt. So possibly
option 'a' was better. Hmm.... Time to think, time to plan... I had a
plan.

Then one day, it happened, it was bound
to. I was assisting Mr X and his forceps rapped my knuckles. Use some
imagination to visualise the scene that I describe next. The instrument I was
holding flies off in one direction, I leap sideways and backwards and slump
down the theatre wall, wailing and shaking my hand. The theatre nurses go red,
Mr X goes pale. I immediately start apologising 'sorry Mr X that must have
caught a sensitive nerve or something'. I proceed to take off my gloves and
gown; I say 'I will be back soon' and walk off to the coffee room. It was an
intermediate type of operation, no harm to patient occurred.

Very soon Mr X finishes the operation,
walks camly across to the coffee room has an arm around my shoulder and says
'Are you okay son?'. I simply mumbled some meaningless neutral words. A few
days later, same theatre coffee room, I had a request for Mr X. It was not a
busy job, my colleagues were excellent and willing. My main interest was surgery
(not orthopaedics) Hence, I wanted to attend Sir Miles Irving's unit at Salford Hospital for half of the week. As a
young surgeon in training, preparing for examinations and the unknown future,
hungry for every morsel of surgical knowledge and exposure - that was exactly
what I wanted then. Mr X's answer, immediately and as expected was 'of course
you can'. Apparently Mr X was never so easily convinced to agree to a
request.

It was a trade off. I knew that it would
happen. I worried about conventional approaches not benefiting anyone. I was
young and proud, I could not simply let it go. So I planned the scenario to get the
best benefit for me under the circumstances. What was done to me was illegal,
it was assault. Acting as per law would have put my career at risk. We can
choose not to press on according to law. That is what I did. I also used
intelligence, planning and emotion to use the situation and get what I wanted,
my own compensation method. What I asked for was not illegal, it was
discretionary and the discretion was used for my benefit. Since then........ I
have got older and wiser. Was it ethical? Was it moral? I do not know, the
reader can make up his/her own mind about it.

What is bullying?

Bullying carries on. Sometimes bullying
these days takes the form of using 'clinical governance', 'patient safety',
'mandatory' issues, 'job planning', 'appraisal', 'pay progression',
'revalidation', in fact the most noble and most benign of tools can become a
weapon in the hands of the unworthy. At the extreme there can be threats
of 'disciplinaries', 'NCAS referrals', 'GMC referrals', etc.

Bullying exists when there is a threat
present in an atmosphere when it should not be present.

The difficulty in dealing with bullying is
about feeling, perceptions of various parties in the mix such as the victim,
perpetrator or investigator. In my view it is not about feelings. There should
be a threat, tangible, palpable, hopefully something can be proven, something
that has a previous record. For any given person, when observed, measured data
shows performance/behaviour within an acceptable band and yet others around
this person use their power based on opinions to set or impose conditions when
none should be set or imposed then bullying exists.

TYPES of Bullying and Dealing with it

Bullying due to Pressure: Normal persons can show expressed behaviours of a bully
when there are excessive pressures e.g. shortage of resources such as staff,
equipment, money or an excess of work such as too many patients or too much
regulation. These can be resolved without reference to the bully; simply by
providing the right resources and systems. Here, the management becomes
responsible for bullying and even more responsible for solving the problem. My
personal opinion as an observer of work environment is that expressed bullying
behaviour due to work pressures is responsible for about 40% to 50% of all
cases of bullying.

Bullying due to personal deficiency of
knowledge: People express bullying behaviour expressed initially as
aggressiveness and eventually abusive behaviour to camouflage their personal
deficiencies of knowledge and the consequent lack of confidence. This sometimes
happens consciously but often without people even realising it. Operational
data will often identify proof of deficiencies in these individuals; this
evidence may not be in the outcomes but in process data. It will be ideal if
the individuals are able to recognise this by themselves often they need a
little pointer from friendly colleagues. In this case, resolution takes the
form of additional development of the individual concerned. Technical
development or non-technical development, often both will be needed. Team
training could be a route to accomplish this. Again, my personal opinion as an
observer of these issues is that this kind of bullying accounts for 40% to 50%
of bulliers.

Bullying due to inherent pathological
behaviour: A small number of individuals have bullying as a psychological
personality trait. These individuals will not recognise themselves or accept the
view of others that they have personality issues. These individuals may even
often have excellent medical/clinical outcomes. These people often are
mis-recognised as excellent performers with an assertive personality and are
actually promoted up the hierarchy – they will shine till the day they burn the
whole edifice down. We need a mature special method of dealing with these
people. These people need to be put in a space with a small group of mature
trusted people (staff who are trusted by the individual and by the
organisation) so that they can carry on their clinical work without affecting
wider morale of the organisation. That would be possible; but it will require
immense managerial effort to do so. These individuals should never be given
positions of power. A smaller number will play up at the end of all this, they
will need to be taken up through formal systems.

Instead of dealing with bullying as above,
we currently either ignore it or when we are not able to ignore we deal with it
through rules and law. Both are inappropriate.

Individuals coping with bullying

Those of us who are not in a position to
implement the above methods will need personal mechanisms to cope. Since the
dated example described above, I have been of course bullied. Sometimes I have
ignored, sometimes I have suffered it (on one occasion nearly 2 years) for
obtaining long term gains, sometimes I have confronted the bully. I have never
had to write in an official bullying and harassment complaint; will not
hesitate to do that if the circumstances were right. Also never hesitated to
wage personal campaigns to make everyone aware of the bully, bullying and
mechanisms to cope – never hesitated to retaliate by damaging the image or
reputations of bullies; I never do it lightly, only after significant evidence
and deep thought.

In the personal mechanism to cope with
bulliers it is important to think, plan and practice extensively on how and
when to confront the bully, when done right bullies stop bothering you. I have
in my personal capacity helped one or two persons do so. It is sad that we may
have to do this to protect ourselves when the systems let us down. Sadly this
method only protects us and the bully moves on to someone else.